9.18 pm

Dr. Richard Taylor (Wyre Forest):
I shall be very brief. I am one of those hon. Members who still has not decided which way to vote this evening or, indeed, whether to abstain, but I have found all the contributions extraordinarily interesting and very helpful.

I am delighted that we have been reminded of the importance of care in the community, yet I am pleased that the hon. Member for North Norfolk (Norman Lamb) reminded us that care homes are essential. One of my constituent's comments about his father were published in the Daily Mail. My constituent said:

"He spent two weeks in residence and enjoyed it so much that he decided to continue to live there."

So care homes are right for some people.

I welcome the opportunity to expose the enormity of the task that the Government face. I agree with them absolutely that investment alone is not enough unless it is matched by reform, but the enormity remains. If the £300 million investment announced in October is broken down into counties, Worcestershire received £713,000. If all that money had been spent on residential care, it would have been enough to provide less than one extra place a week. I am not criticising the amount, but merely pointing out the enormity of the task.

The cost of care is not met by social services in my county. I would almost like to arrange a visit to Stockton to see how it does that. Care homes in my constituency hope to take large numbers of fee-paying patients because they subsidise those who are paid for by social services.

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I shall end my brief contribution with a plea from the chair of the care homes association in Hereford and Worcester that the Minister might have seen. He writes:

"In 2001/2 Worcestershire receives £53 million in respect of payments for Residential and Nursing Care and Domiciliary Care. However, due to political decisions in the Council Chamber, only £33 million is used for the purpose intended".

Will the Minister investigate that claim? If it is correct and if it applies to other parts of the country, will she take action?

9.21 pm

Sue Doughty (Guildford):
I enjoyed the news from God's own county. It is very much a contrast to life in Surrey. My father is 80 and lives in Yorkshire and I have told him. "Don't come south. Stay in Yorkshire." [Hon. Members: "Go to Stockton."] I am not going as far as Stockton.

Many Members have spoken about what is almost crisis management and the problem is not that we resent it if care homes make a profit. Any business can stay in business only if it makes a return on its investment. The cost of living and the price of property is so high in Surrey that investing in care homes involves a bad return on investment. That is the problem.

We still want good-quality care homes and we support high standards in them. However, we recognise the need to fund the provision of that care. Those of us who have constituents who have been bedridden for more than a year as a result of poor care have plenty of reason to desire improvements to the standard of nursing in some care homes.

We are in crisis, but the Minister would be hurt if I did not recognise the contribution that "cash for change" has made to bed blocking in Surrey. Even though, as in other areas, there have been massive queues in accident and emergency departments and even though people have been virtually imprisoned in wards in the Royal Surrey hospital, some improvements have been made. Notwithstanding that, we need ongoing planning so that care homes can plan. Furthermore, we need the money to train and pay care workers to look after people in their homes. Without that funding and without the recognition that counties cannot pay with money that they do not have, we will make no progress.

Some care workers in Surrey work for 10 hours a day, unpaid for some of the time. They do not have enough time in the day to look after people, and that is not good enough. We need to treat people with decency. One of the problems is that there are not enough care workers in Surrey because they cannot afford to live there. However, we cannot bring them in from overseas, as we can nurses, because they are not at national vocational qualification level 3. People advertise throughout the country, but no one responds and we cannot bring people in from elsewhere. Consideration must be given to that point.

We have not touched on care for those who care for others. Although we have considered the revolving-door syndrome and bed blocking, a report commissioned by Help the Aged shows that one third of all carers over the age of 75 provide 50 hours of care a week. Three quarters of older people who live with the person for whom they care receive no regular visits from health or social services. One in 10 older carers who live with the person whom they look after receive home care themselves.

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Carers over 75 are more likely to be providing intensive care than those between 60 and 74. By 2031, nearly one in three of the population will be over 60.

We all want people to lead happy and healthier lives, but we have to recognise that we not only have to meet the current crisis but have to plan for the long-term needs of the population. We need long-term, consistent planned growth, based on realistic costs of providing social care of a quality that not only meets Government objectives, but provides plain and common decency for our older people.

9.25 pm

Mrs. Patsy Calton (Cheadle):
The Government amendment implies that all is improving in care for the elderly. The simple truth is that it is not. Every word of the Liberal Democrat motion will ring true with social services departments, the health service and, more important, users of the services and their carers up and down the landperhaps with the exception of Stockton.

The Government are not doing enough in the round and the problems start with local government finance. I speak as a past chair of social services in Stockport, where we welcomed many of the social care modernisation reforms demanded by the Government. We are proud of working jointly with the health service and the voluntary sector, and we improved our management and record keeping. Basically, we did our best and the social services department in Stockport continues to do its best against both a backdrop of structural problems associated with local government funding of social services departments and a general backdrop of underfunding of local authorities in many parts of the country.

I wish to explore two issues. The first is the structural problem caused in budgets by the chronic underfunding of children's services. In Stockport, crude standard spending assessment measures do not reflect the levels of need of children within our community. The knock-on effect of meeting the needs of children's services is to steal money from older people's services, with the resultant increases in gatekeeping. That reduces social services departments' ability to provide the right service at the right time for the elderly. All too often, money has to be spent on firefighting instead of ensuring a dignified and supported older age for the infirm. The lack of funding in older people's services leads to bed blocking and to entry to residential care, two outcomes that the vast majority of older people and their carers do not want.

The second issue that I wish to explore is the shortsighted way in which the Government tackle the problems. By the time someone becomes infirm, it is almost too late to engage in issues to do with lifestyle and diet. All the evidence indicates that as our young people get older, their sedentary lifestyle and poor diet, which we know is causing obesity, will lead to greater dependency when they reach an older age. The Government are engaged in pilot schemes such as the school fruits initiative, but they need to do much more to counteract the insidious effect of junk food and drinks machines in school corridors and sports centres throughout the country. Young people used to engage in more vigorous activity in schools, and more needs to be done to establish a better balance between activity and academic work in their lives.

In addition, more attention needs to be paid to the difference that local authority leisure services can make. France, for example, spends eight times as much on sport

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per head as we do. Leisure services are also often starved of cash because of the needs of other departments, like social services, that are busy firefighting.

I am disappointed that four and a half years on, a Government with a big majority have not come up with proposals to replace the discredited local government finance system. Until they do, SSAs will continue to fail to meet people's needs and the improvements demanded by the Government cannot be implemented.

9.29 pm

Dr. Evan Harris (Oxford, West and Abingdon):
We have had a good debate, started by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), who stated the position clearly and backed up his remarks with evidence. It is important to provide data as well as solutions to the problems we see.

Using House of Commons Library figures derived from Government answers, my hon. Friend demonstrated that there are bottlenecks and delays in the health service. In the last year, 1,400 years of elderly people's time has been spent waiting to get out of hospital. The Minister may dispute those figuresperhaps she thinks it is only 1,300 years. However, the facts are clear and the Government must acknowledge them before they can claim that they are starting to solve the problem.

My hon. Friend demonstrated the loss of beds and homes in the care sector. He pointed out the cash shortages affecting many social services authorities, leading to a macabre game of musical beds wherein people who require funding can be placed only when one or more care home residents who are funded die. What a sad game to which to subject the elderly people of this country.

My hon. Friend further demonstrated the diminishing eligibility criteria caused by cash shortages, which lead to ever fewer people qualifying for any help from social services, as well as the staff shortages, vacancies and high turnover. Sensibly, he called for a review of the social care sector. In a thoughtful contribution, the hon. Member for Stroud (Mr. Drew) pointed out how much thinking is needed in that respect. An independent review of how to get best practice across the country, new thinking and the funding required is long overdue.

Not only have the Liberal Democrats come up with that proposal, but we are prepared to state that we would put in extra investment and to say where that funding would come from. We have talked about extra investment to tackle delayed discharges. According to figures given by the Chairman of the Select Committee on Health, tackling delayed discharges in one year would release £720 million. In addition, we would free councils to raise revenues, as voters elected them to, to meet the needs of local people.

Unlike the Labour party, the Liberal Democrats said at the last election that we would be prepared to increase taxation, including setting a new top rate of 50p in the pound for incomes exceeding £100,000. According to Government figures, that would yield an additional £3.7 billion to spend on elderly people, including those in health care settings.

Ministers may disagree with asking better-off people to pay more to help the most vulnerable in society. I think that to do so is wrong, unreasonable and a betrayal of their principles. They cannot deny that we went into the

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election with a costed manifesto to deliver whatever cash the Labour Government had to spend plus £3.7 billion derived from having the courage to ask the better-off to help to protect the most vulnerable people in our society.

Ministers and their yes men and women on the Back Benches should be ashamed of having lacked the courage to say beforenot afterthe election that taxes would have to rise. They ruled out the only fair way to raise those funds, which is progressive direct taxation rather than stealth taxes. I suspect that many Labour Members wish that their Government's policy was different.

The Minister's response was astonishing, but nothing we have not heard before: "Crisis? What crisis?" She was eloquently and loyallyI hope it is worth itsupported by her hon. Friend the Member for Stockton, South (Ms Taylor), who claimed that there was no problem of elderly people requiring earlier discharge or better services. The hon. Lady was prepared to say that there was a "demographic problem" but added that these are the early days of the Labour Government. If these are the early days, lord help those who need help when the Government have got into the swing of things. She said that there were no lost care homes and no problems, and only two elderly people were suffering from delayed discharge. The Government's new policy to modernise the health care system will be to tell people who want to be discharged from hospital to go to Stockton.

By contrast, we heard testimony from my hon. Friend the Member for North Norfolk (Norman Lamb) about the problems in Norfolk, from my hon. Friend the Member for Cheadle (Mrs. Calton) about the problems in Stockport, from the hon. Member for Wyre Forest (Dr. Taylor) about the problems in his constituency, and from my hon. Friend the Member for Guildford (Sue Doughty) about the problems that still exist in Surrey. In my own constituency, care homes that had survived years of Tory cuts had to close under a Labour Government, and now there is a shortage of beds and a huge increase in the number of delayed discharges in my local hospital.

It is remarkable that the Government refused to acknowledge those problems. The Minister admitted that there was a need to stabilise the private care home sector. If it needs stabilisation, that implies that there is already a problem. What does stabilisation mean? It means rescuing the situation, and she should admit that her limited funding is designed to do that.

The Minister's response was clever but unfair. She chose to centralise praise for the Government every time new money was announced, but decentralise blame to local councils when underfunding led to cuts in provision. She was supported in her tactic of blaming local councilsa few of them Liberal Democrat, but most of them notand attacking the Labour-led Local Government Association by the hon. Member for Eastbourne (Mr. Waterson) and the hon. Member for Isle of Wight (Mr. Turner), who did not even remain in the Chamber to hear the rebuttal of his weakly put point.

The Minister talked about £300 million to tackle delayed discharge and to stabilise the private care home sector. That is not £300 million a year: it is £100 million in the first year and £200 million in the second. We are used to such double counting, but social services

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departments despair of it. We do not even know whether that will be recurrent. We certainly know that it is not the £700 million that the independent King's Fund has established is required, and we would provide at least as much by releasing those acute beds, as the hon. Member for Wakefield (Mr. Hinchliffe) said.

The Minister does not put enough money in, but claims praise for the money that she does provide. She blames hospitals for delayed discharges by naming and shaming them, and by giving them zero rating when they are unable to discharge patients and do not have the capacity to admit others.

Ministers stand at the Dispatch Box and praise staff in the care home sector, but when care homes cannot afford to pay staff adequately they blame the employers. The Minister claimed that 5 per cent. more people receive intensive domiciliary care, and praised the Government for that. She blamed local councils for the fact that 19 per cent.93,000 peoplereceive less care. She probably thinks that it is a triumph that people who do not qualify for care under the tightened eligibility criteria are happily living independent lives, but they are heading more quickly towards high-level care because of the failure of early intervention.

The Minister claimed to have tackled the problem through the establishment of the high-level, strategic commissioning group. Bully for her! That group has come up with fantastic ideas such as long-term contracts. Of course long-term contracts are a good idea, but long-term funding to go with them would be helpful.

The contribution of the hon. Member for Wakefield was interesting. At least he accepted that there was a capacity problem. Like us, he accepted that the ideal would be independent living and less institutional care. Although care homes are suitable for some people, we should not assume that they are suitable for everyone.

The hon. Gentleman said that he disapproved, as he has always done, of the structural divide between health and social care: what the Government describe as a Berlin wall, and what my local trust and social services department describe as a Berlin trench, as they are digging to find the funds to fulfil the extra duties imposed on them by Government. We agree with the hon. Gentleman on that point. He accepted that 6,000 people suffer delayed discharge on any one day, and he pointed out that it would save £720 million if that problem were tackled. Again, he agrees with us and our motion.

The hon. Gentleman said that social services were underfunded compared with the health service, and that the real-terms increase in social services was not keeping pace. Again, he agrees with our point of view. He criticised the Government for their non-evidence-based love affair with private sector provision of social care. He supports us in almost everything, but then announces that he will support the Government in the Lobby tonight. Wheels within wheels. If the hon. Gentleman disagrees with the Government but will vote for them when the crunch comes, it is not scrutiny but tribalism. I say with the greatest respect, because the hon. Gentleman is bigger than me, that those who agree with our criticisms ought to follow the logic of their position.

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The hon. Member for West Chelmsford (Mr. Burns), one of the few Conservative Members in the Chamber tonight, confirmed in an honest speech that his party in opposition is committed to funding only nursing care, not personal care. [Interruption.]